Computed tomography of abdomen (CTA) in management of blunt abdominal trauma

We reviewed our initial 2-year experience utilizing CT of the abdomen (CTA) in the management of blunt abdominal trauma. Thirty-four of 176 patients (19%) admitted with this diagnosis during 1987-88 underwent CTA as part of their initial evaluation. All patients were hemodynamically stable. Of the 34 CTA's, 15 were negative and the remaining 19 showed positive findings. When the CTA was negative, it was correct in 14 of 15 cases (93%). One case of a perforated jejunum was missed. Of the 19 positive CTA's, 12 cases were treated by observation. The CTA diagnosed a variety of intra- and extraperitoneal injuries which were successfully managed nonoperatively. It, however, missed findings in two cases. Seven of 19 positive CTA cases underwent laparotomy. CTA missed findings in four of these cases. These errors may have been related to the quality of the CTA technique which was subsequently assessed to be suboptimal. When positive, CTA was correct in 13 of 19 cases (68%). The overall accuracy rate was 79% (27 of 34). Subsequent review of the CT scans, however, improved the accuracy rate to 88% (30 of 34). CTA was found to be a valuable adjunct to clinical monitoring in the management of blunt abdominal trauma. However, if the utilization of CTA does not include appropriate patient selection, standardized CTA technique, and accurate radiologic interpretation, there is a significant potential for serious error.